<extend name="./Tm/Dt/User_common.html" />

<block name="main">
	<div class="right_main">
		<div class="panel panel-default">
		  	<div class="panel-heading">
		  		<i class="inde_icon icon_jjmx"></i>提现管理</span>
		  	</div>
	  		<div class="panel-body">
				<form class="form-horizontal pp" action="/user/zl_xg" method="post">
					<div class="form-group">
						<label for="inputPassword3" class="col-sm-2 control-label">会员账户：</label>
						<div class="col-sm-4 pad-top-8">
							<p>{$Think.session.username}</p>
						</div>
					</div>
					<div class="form-group ">
						<label for="inputPassword3" class="col-sm-2 control-label">姓名：</label>
						<div class="col-sm-4 pad-top-8">
							<p>{$Think.session.name}</p>
						</div>
					</div>
					<div class="form-group">
						<label for="inputEmail3" class="col-sm-2 control-label">身份证号码：</label>
						<div class="col-sm-4">
							<input type="text" class="form-control" id="inputEmail3" placeholder="" value="{$Think.session.cart_id}" name="sfz">
						</div>
					</div>
					<div class="form-group">
						<label for="inputPassword3" class="col-sm-2 control-label">开户行：<span>*</span></label>
						<div class="col-sm-4">
							<input type="text" class="form-control" id="inputPassword3" placeholder="" value="{$Think.session.khyh}" name="khyh">
						</div>
					</div>
					<div class="form-group">
						<!-- <label for="inputPassword3" class="col-sm-2 control-label">开户姓名：</label>
											    <div class="col-sm-4">
											      <p>{$Think.session.khxm}</p>
											    </div> -->
						<label for="inputPassword3" class="col-sm-2 control-label">开户姓名：<span>*</span></label>
						<div class="col-sm-4">
							<input type="text" class="form-control" id="inputPassword3" placeholder="" value="{$Think.session.khxm}" name="khxm">
						</div>
					</div>
					<div class="form-group">
						<label for="inputPassword3" class="col-sm-2 control-label">银行卡号：<span>*</span></label>
						<div class="col-sm-4">
							<input type="text" class="form-control" id="inputPassword3" placeholder="" value="{$Think.session.yhkh}" name="yhkh">
						</div>
					</div>
					<div class="form-group">
						<label for="inputPassword3" class="col-sm-2 control-label">支行信息：<span>*</span></label>
						<div class="col-sm-4">
							<input type="text" class="form-control" id="inputPassword3" placeholder="" value="{$Think.session.zhhxx}" name="zhhxx">
						</div>
					</div>
					<div class="form-group">
						<label for="inputPassword3" class="col-sm-2 control-label">省、市、地区：</label>
						<div class="col-sm-4">
							<input type="text" class="form-control" id="inputPassword3" placeholder="" value="{$Think.session.province}" name="dzhi">
						</div>
					</div>
					<div class="form-group">
						<div class="col-sm-offset-2 col-sm-10">
							<button type="submit" class="btn btn-primary">提交</button>
						</div>
					</div>
				</form>
			</div>
		</div>
	</div>
</block>